fighting with insurance

If I get a denied letter...can I resubmit or call my insurance to try to fight for surgery? Or is this a waste of time?

Fight, fight, fight! It took me TWO AND A HALF YEARS to get approved! Find out why they are denying you - could be something as simple as needing a letter from your PCP or a record of past failed diets.

The only problem that i can see is that I am just under 200 lbs.  WHile this may not be anywhere near as much as most people getting WLS due to chronic pain I cannot excercise to lose weight.  So should I call my insurance?

Find out exactly WHY they are denying you - that's the first step. It may be something you can correct.

It is the weight.  I am not with a BMI of 35 with co-morbidities.  I am 34 with scoliosi, plantar fascitis and GERD.  I guess they don't realize I can't excercise due to pain.

I have read of a lot of success stories in getting insurance approval after being denied, but not any where someone had a BMI under 35 - they are pretty strict on that one.  The only reason they pay for WLS in the first place is it saves lives and they have drawn the line at a BMI of 35+ as being life-threatening.  The reason they ask for 5 years of weight records is so someone doesn't try to put in 20 pounds to get surgery approval.  And no - they do not care if you can exercise or not.

What surgery were you going for?  Any way you could self-pay and finance it yourself?  The surgery isn't magic - you still have to diet and exercise to lose weight - it just helps you stay on it by making it painful to make poor choices. 

I am sorry you have been denied - I don't agree with the rules the insurance companies make and think the surgery should be available on a case-by-case basis.

That is just dealing with Tricare Select.  I am going to call them tomorrow and try to work this out.  I would rather just have VSG but, if I had no choice then Lap Band would have to be it.

Good luck and I hope it works out for you.

I have had plantar fascitis and it is extremely painful!  I used to get out of bed every morning and grab the dresser to support me while I crippled to the bathroom with knives shooting in the bottoms of my feet until the tendons stretched out.

I managed to exercise, but only on an exercise bike and one you could lean back on so it didn't hurt my back.  Couldn't do a treadmill - no way!  My gym had a lap pool so I did a lot of laps and water aerobics, too.

I cured my plantar fascitis flare-up (guess it is never "cured") by paying for custom orthotics myself.  My insurance company would only pay for them if I was diabetic, which angered me - my feet hurt just as much as a diabetics!  But my feet pain wasn't going to cause me to lose my feet - that is how they think.  And yet - they would pay for very expensive foot surgery which I did not want.  Grrrr........

Appeal the decision due to your health issues.  However, saying this usually with a BMI of less than 35 most insurances won't pay.

I wouldn't normally say gain weight but how close are you to a BMI of 35?  If it's a matter of 5-6 lbs then by all means I'd do my best to put on 5-6 lbs and reapply.

Good luck!